Pelvic Floor Muscle Training for Voiding Dysfunction in Cervical Cancer Survivors with Radiation Cystitis: A Prospective Pilot Study

Abstract

Introduction: The primary pathophysiology of radiation cystitis is the rupture and bleeding of telangiectatic blood vessels as a result of bladder distension. The objective of the study is to evaluate the effectiveness of pelvic floor exercises in improving pelvic floor muscle strength and thereby improving voiding dysfunction.

Materials and Methods: We included 30 patients who presented to our Institute with radiation cystitis between January 2023 and December 2023. Participants were taught pelvic floor muscle (PFM) exercises to strengthen the pelvic floor muscles. Improvements to the Modified Oxford Scale (MOS) and Stop score for pelvic floor muscles and post void residual urine were tested after 4 weeks. The role of contributing factors for pelvic floor muscle dysfunction like voiding habit and uncontrolled blood sugars were also assessed.

Results: The median score of the Modified Oxford Scale (MOS) improved from 2 to 3 post PFM exercises. [p-value < 0.001]. Similarly, the median Stop score of patients improved to 2 from 1.5 with PFM exercises. [p-value 0.006]. There was significant reduction in post void residual urine after one month of exercises. [p-value < 0.001] Around 37% of patients had uncontrolled diabetes at the presentation of radiation cystitis and 60% of patients had the habit of voiding urine in the standing position.

Conclusion: Early initiation of pelvic floor exercises, patient education on proper voiding habits, can increase the pelvic muscle strength and significantly decrease post void residual urine. This might have a potential role in decreasing the radiation cystitis which needs to be validated in future randomised control studies with long term follow up.